title: Patient ability and willingness to participate in a web-based intervention to improve hypertension control.
abstract: BACKGROUND
  Patient-shared electronic health records provide opportunities for care outside of office visits. However, those who might benefit may be unable to or choose not to use these resources, while others might not need them.
  
  
  OBJECTIVE
  Electronic Communications and Home Blood Pressure Monitoring (e-BP) was a randomized trial that demonstrated that Web-based pharmacist care led to improved blood pressure (BP) control. During recruitment we attempted to contact all patients with hypertension from 10 clinics to determine whether they were eligible and willing to participate. We wanted to know whether particular subgroups, particularly those from vulnerable populations, were less willing to participate or unable to because they lacked computer access.
  
  
  METHODS
  From 2005 to 2006, we sent invitation letters to and attempted to recruit 9298 patients with hypertension. Eligibility to participate in the trial included access to a computer and the Internet, an email address, and uncontrolled BP (BP ≥ 140/90 mmHg). Generalized linear models within a modified Poisson regression framework were used to estimate the relative risk (RR) of ineligibility due to lack of computer access and of having uncontrolled BP.
  
  
  RESULTS
  We were able to contact 95.1% (8840/9298) of patients. Those refusing participation (3032/8840, 34.3%) were significantly more likely (P < .05) to be female, be nonwhite, have lower levels of education, and have Medicaid insurance. Among patients who answered survey questions, 22.8% (1673/7354) did not have computer access. Older age, minority race, and lower levels of education were risk factors for lack of computer access, with education as the strongest predictor (RR 2.63, 95% CI 2.30-3.01 for those with a high school degree compared to a college education). Among hypertensive patients with computer access who were willing to participate, African American race (RR 1.22, 95% CI 1.06-1.40), male sex (RR 1.28, 95% CI 1.18-1.38), and obesity (RR 1.53, 95% CI 1.31-1.79) were risk factors for uncontrolled BP.
  
  
  CONCLUSIONS
  Older age, lower socioeconomic status, and lower levels of education were associated with decreased access to and willingness to participate in a Web-based intervention to improve hypertension control. Failure to ameliorate this may worsen health care disparities.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00158639; http://www.clinicaltrials.gov/ct2/show/NCT00158639 (Archived by WebCite at http://www.webcitation.org/5v1jnHaeo).
authors.affiliation: Group Health Research Institute, Seattle, WA, USA. green.b@ghc.org
authors.forename: Beverly B
authors.initials: BB
authors.lastname: Green
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Anderson
authors.forename: James D
authors.initials: JD
authors.lastname: Ralston
authors.forename: Sheryl
authors.initials: S
authors.lastname: Catz
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fishman
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Cook
mesh_terms: D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory; D004522:Educational Status; D057286:Electronic Health Records; D034742:Electronic Mail; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy* / Q000208:ethnology / Q000209:etiology; D020407:Internet; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010342:Patient Acceptance of Health Care; D016012:Poisson Distribution; D012306:Risk; D012737:Sex Factors; D012923:Social Class